Seclusion and enforced medication in dealing with aggression:A prospective dynamic cohort study

AbstractBackgroundIn the Netherlands, seclusion is historically the measure of first choice in dealing with aggressive incidents. In 2010, the Mediant Mental Health Trust in Eastern Netherlands introduced a policy prioritising the use of enforced medication to manage aggressive incidents over seclusion. The main goal of the study was to investigate whether prioritising enforced medication over seclusion leads to a change of aggressive incidents and coercive measures.MethodsThe study was carried out with data from 2764 patients admitted between 2007 and 2013 to the hospital locations of the Mediant Mental Health Trust in Eastern Netherlands, with a catchment area of 500,000 inhabitants. Seclusion, restraint and enforced medications as well as other coercive measures were gathered systematically. Aggressive incidents were assessed with the SOAS-R. An event sequence analysis was preformed, to assess the whether seclusion, restraint or enforced medication were used or not before or after aggressive incidents.ResultsEnforced medication use went up by 363% from a very low baseline. There was a marked reduction of overall coercive measures by 44%. Seclusion hours went down by 62%. Aggression against staff or patients was reduced by 40%.ConclusionsWhen dealing with aggression, prioritising medication significantly reduces other coercive measures and aggression against staff, while within principles of subsidiarity, proportionality and expediency.</jats:sec

Raising the Bar: Improving Methodological Rigour in Cognitive Alcohol Research

Background and Aims: A range of experimental paradigms claim to measure the cognitive processes underpinning alcohol use, suggesting that heightened attentional bias, greater approach tendencies and reduced cue-specific inhibitory control are important drivers of consumption. This paper identifies methodological shortcomings within this broad domain of research and exemplifies them in studies focused specifically on alcohol-related attentional bias. Argument and analysis: We highlight five main methodological issues: (i) the use of inappropriately matched control stimuli; (ii) opacity of stimulus selection and validation procedures; (iii) a credence in noisy measures; (iv) a reliance on unreliable tasks; and (v) variability in design and analysis. This is evidenced through a review of alcohol-related attentional bias (64 empirical articles, 68 tasks), which reveals the following: only 53% of tasks use appropriately matched control stimuli; as few as 38% report their stimulus selection and 19% their validation procedures; less than 28% used indices capable of disambiguating attentional processes; 22% assess reliability; and under 2% of studies were pre-registered. Conclusions: Well-matched and validated experimental stimuli, the development of reliable cognitive tasks and explicit assessment of their psychometric properties, and careful consideration of behavioural indices and their analysis will improve the methodological rigour of cognitive alcohol research. Open science principles can facilitate replication and reproducibility in alcohol research

Errors in the method of line-reversal

It is shown that with a favourable experimental design the random error in the temperature measurement of hot gases with the method of line-reversal is of the order of 1 deg. K at about 2500°K. A number of Systematic errors, each of the order of 10 deg.K, are considered. Some applications of the method are discussed quantitatively and a procedure is indicated for the reversal measurement of gas temperature which are higher than the brightness temperature of the available background light source

A review and tutorial discussion of noise and signal-to-noise ratios in analytical spectrometry—III. Multiplicative noises

In this review, signal-to-noise ratios are discussed in a tutorial fashion for the case of multiplicative noise. Multiplicative noise is introduced simultaneously with the analyte signal and is therefore much more difficult to reduce than additive noise. The sources of noise, the mathematical representation of noise, and the major types of noises in emission and luminescence spectrometry are discussed. If the limiting source of noise is multiplicative white noise, the signal-to-noise ratio for optimal sampling time τs increases as the square root of the response or integration time of the readout and is independent of the rate at which sample and reference are measured. The variation of multiplicative flicker noise with variation in sampling time, τs, time interval between sample and reference measurements, T, and response (τr) or integration (τi) time is discussed in some detail. The optimal system for the case of multiplicative noise is a dual channel approach in which the sample and reference are measured simultaneously and a ratio of signals is taken. Although the best reference in most cases of interest to analytical chemists is a calibration standard, it is often impossible to measure a sample and a calibration standard simultaneously and so an internal standard, a detector monitoring the source intensity, etc., may be useful